What protein drinks or powders are suitable for a diabetic patient with a wound who requires increased protein intake?

Protein Supplementation for Diabetic Patients with Wounds

For a diabetic patient with a wound requiring increased protein intake, standard protein supplements are generally not recommended as they have not been proven to improve wound healing outcomes, but if supplementation is pursued despite limited evidence, choose products with 20-30% protein content, low in simple carbohydrates, and monitor blood glucose closely. 1

Evidence Against Routine Protein Supplementation

The most recent and highest-quality guideline evidence strongly recommends against using protein supplementation specifically to enhance diabetic wound healing:

• The 2024 IWGDF guidelines explicitly state: "Do not use pharmacological agents that stimulate red cell production or protein supplementation to improve wound healing outcomes over standard of care" (Strong recommendation; Low quality evidence). 1

• The 2020 IWGDF guidelines similarly concluded: "Do not use interventions aimed at correcting the nutritional status (including supplementation of protein, vitamins and trace elements) of patients with a diabetic foot ulcer, with the aim of improving healing, in preference to best standard of care" (Strong recommendation; Low quality evidence). 1

• A 2020 Cochrane systematic review found that an oral nutritional supplement containing arginine, glutamine, and β-hydroxy-β-methylbutyrate showed uncertain effects on ulcer healing at 16 weeks compared with placebo (RR 1.09,95% CI 0.85 to 1.40), with very low certainty evidence. 2

General Protein Requirements for Diabetics

Despite the lack of evidence for wound healing enhancement, understanding baseline protein needs remains important:

• For individuals with diabetes and normal renal function, usual protein intake of 15-20% of total energy is appropriate and should not be routinely modified. 1

• The acceptable macronutrient distribution range for protein is 10-35% of energy intake, with an RDA of 0.8 g good-quality protein per kg body weight. 1

• In persons with diabetes, especially those not in optimal glucose control, protein requirements may be greater than the RDA but typically not greater than usual intake. 1

• Moderate hyperglycemia in type 2 diabetes can contribute to increased protein turnover, suggesting potentially increased protein needs. 1

Critical Considerations for Product Selection

If you choose to provide protein supplementation despite guideline recommendations against it for wound healing, consider these factors:

Carbohydrate Content

• In persons with controlled type 2 diabetes, ingested protein does not increase plasma glucose concentrations, although protein is just as potent a stimulant of insulin secretion as carbohydrate. 1

• Choose products low in simple carbohydrates and sugars to minimize glycemic impact. 1

• The total amount of carbohydrate is more important than the source or type for glycemic effects. 1

Fat Content

• Limit products high in saturated fat to <7% of total calories. 1

• Minimize trans fat intake completely. 1

• Limit dietary cholesterol to 200 mg/day, as persons with diabetes appear more sensitive to dietary cholesterol than the general public. 1

Specific Product Characteristics

• Look for whey or casein-based protein powders with minimal added sugars (ideally <5g per serving). 1

• Consider products fortified with vitamins and minerals, though evidence for their benefit in wound healing is lacking. 1

• Avoid products marketed specifically for "wound healing" with arginine, glutamine, or β-hydroxy-β-methylbutyrate, as these showed no clear benefit in clinical trials. 1, 2

Important Pitfalls and Caveats

Do Not Use Protein to Treat Hypoglycemia

• Protein should NOT be used to treat acute hypoglycemia or prevent nighttime hypoglycemia, as it can increase insulin response without increasing plasma glucose concentrations. 1, 3

• Use glucose tablets, gel, or liquid for hypoglycemia treatment instead. 3

Renal Function Monitoring

• High-protein diets (>20% of calories) have unknown long-term effects on kidney function in persons with diabetes. 1

• For patients with diabetic kidney disease (micro- or macroalbuminuria), reducing protein intake below usual levels is not recommended. 1

• Ensure renal function is assessed before recommending increased protein intake. 1

Realistic Expectations

• Most adults already consume at least 50% more protein than required, so additional supplementation may be unnecessary. 1

• The metabolic cost of wound healing and nutrient losses through wound exudate may increase protein needs, but this has not translated to improved healing outcomes with supplementation in clinical trials. 1, 2

Practical Approach

Given the strong evidence against protein supplementation for wound healing, the most appropriate recommendation is:

1. Ensure adequate baseline protein intake through whole food sources (lean meats, fish, poultry, eggs, dairy, legumes) targeting 15-20% of total calories or 0.8-1.0 g/kg body weight. 1

2. If the patient has documented protein-energy malnutrition or inadequate oral intake, consider a standard diabetes-appropriate oral nutritional supplement (not specifically marketed for wound healing). 2

3. Monitor blood glucose closely if supplementation is initiated, as protein stimulates insulin secretion. 1

4. Focus on evidence-based wound care (offloading, debridement, infection control, vascular assessment) rather than nutritional interventions for wound healing. 1